{
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"EIN": null,
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"LastName": "BLACKWELDER",
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"OtherOrgName": null,
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"OtherLastName": "MORGAN",
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"OtherCredential": "ENP",
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"FirstLineMailingAddress": "1140 JAMIE LN",
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"MailingAddressCityName": "GERMANTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27019-9157",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-994-4005",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "J R JONES MEDICAL CENTER",
"SecondLinePracticeLocationAddress": "402 WEST KING ST",
"PracticeLocationAddressCityName": "KING",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-983-9617",
"PracticeLocationAddressFaxNumber": "336-983-9791",
"EnumerationDate": "03/15/2006",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "700003",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}